HomeMy WebLinkAboutWPO201500019 Preconstruction Form 2015-06-25 •
Request for Pre-construction Meeting and Grading Permit
J ® 4
from Albemarle County .z
Approved Plan Number: WPO- ZO tc — 000 l9
Approved Plan Name: Vier%(, Q1eoceal '1,15 POM t_ A 4A
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date:
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name. W itsLl f M M A\i
State Certification Number: 38 4A?j
Address IOW IA*49E14 A\Sr4vE
City ti1.4.1442l,011-66uL1.4.E State \U4 Zip ZZ9.UZ
Daytime Phone( ' ) at_ 431't E-mail s t/e( -As Not,
Primary Contractor: J
Print Name Wee-lg cMOLC 5-N e- ses tIJG
Address IOZp litt42Ei1 AV'ENVE,
City Gi4AIZLO-fl S'4t1.LE State ' 4 Zip ZZ902
Daytime Phone(454) Z44. OZ$2) E-mail V1/41.SH,iWI -6C-cL,eis , cook
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application.
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63 80
1 and less than 5 $594.00
5 and less than 10 $748 00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112 00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised: 8/29/14 Page 1 of 3
Person(s) to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
Va1t 1. FLeu Q'S w44tvie.l Qce-tl ,tart/434Li81-4511
W+WS l•kt5 c 6ave+tz'S GtKxce Nict514; e eQr.e.-Aacis.tows 143+-1U-3193
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who'
7/1/14, Revised: 8/29/14 Page 2 of3